Medical Care Research Unit

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Acupuncture for low back pain a pragmatic
randomised controlled trial   Hugh MacPherson
PI Kate Thomas
Deputy DirectorMedical Care Research
UnitFaculty of MedicineUniversity of Sheffield,
UK
Research Director Foundation for Traditional
Chinese Medicine, York, UK
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Testing the hypothesis that.

• . primary care patients with persistent low
  back pain, when given access to an acupuncture
  service, gain more relief from pain than those
  offered usual management only, for equal or less
  cost.

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Pragmatic research design - evaluating
comparative effectiveness

• Patients with low back pain (duration 4 to 52
  weeks)
• Referred by their General Practitioner (GP)
• Randomised to receive either
• 10 individualised acupuncture treatments as well
  as usual GP management
• usual GP management only

or
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Outcomes at 3, 12 and 24 months

• Primary outcome
• SF-36 Bodily Pain (scale 0 to 100)
• at 12 and 24 months
• Economic measures at 24 months
• SF-6D, EQ-5D

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Demographic profiles (at baseline)
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Acupuncture treatments provided

• Average 8 treatments per patient, usually weekly
• Commonly selected points
• Bladder points BL-23, BL-26, BL-53, BL-40
• Gall Bladder points GB-30, GB-34
• Local points Huatou at L3, L4 and L5, AhShi
  points
• Syndrome points KID-3
• Auxiliary techniques and advice

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SF-36 Bodily Pain Scale 3 months

Diff5.5 pts p0.079
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SF-36 Bodily Pain Scale 12 months
Diff6.0 pts P0.074
Diff5.5 pts p0.079
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SF-36 Bodily Pain Scale 24 months
Diff9.0 pts P0.015
Diff6.0 pts P0.074
Diff5.5 pts p0.079
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Worry about back pain at 24 months
Diff. between groups Plt0.001
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At randomisation Do you believe that
acupuncture can help your low back pain?
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Conclusions

• It is possible to conduct a pragmatic RCT of
  individualised acupuncture in primary care
• Acupuncture is clinically beneficial (and
  cost-effective) for low back pain over the
  longer-term
• Results are unlikely to be due to belief

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Acknowledgements

• Acupuncturists
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• Wendy Epstein
• Alison Gould
• Liping Han
• Harriet Lansdown
• Hugh MacPherson
• June Tranmer
• Advisors
• David Laverick
• Trevor Sheldon
• Sally Bell?Syer
• Patients

• Research Team
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• Kate Thomas (PI)
• Hugh MacPherson
• Lucy Thorpe
• John Brazier
• Mike Campbell
• Mike Fitter
• Ann Morgan
• Jon Nicholl
• Liz Oswald
• Mark Roman
• Helen Wilkinson
• Funders
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• NHS Health Technology
• Assessment Programme